2008 GREAT LAKES REGIONAL PUPPETRY CONFERENCE REGISTRATION FORM

2008 GREAT LAKES REGIONAL PUPPETRY CONFERENCE

June 26-29th, 2008, Shipshewana IN

(Please return to: Terri Klingelhoefer, Registrar, 7251 W State Road 46 Ellettsville IN 47429. Phone 812-325-9326)

 

First Membership                 Adult ___ Child (6-18) ___                                P of A Membership #_________

 


First Name______________________ Last Name______________________________

Title__________________________________________________________________

Company______________________________________________________________

Address _______________________________________________________________ ______________________________________________________________________

City_____________________________ St._____ Zip___________________________

Country_______________________________ Foreign Postal Code________________

Phone ____________________________ Cell_________________________________

Email__________________________________________________________________

Emergency contact person: ______________________Onsite? Y N    Phone__________

PLEASE PRINT! Additional memberships to be sent to same address above:

 

First Name                            Last Name

Adult

Child

1

 

 

 

2

 

 

 

3

 

 

 

4

 

 

 

 

 

 

 

 

 

 

 

(You may attach a page with additional memberships/info if you have more than four.)

 

 

Item

 

Qty

Postmarked

by 3/1/08

Postmarked

by 5/31/08

Postmarked

after 5/31/08

 

Total due

Adult Registrations

 

$135

$150

$170

 

Child Registrations

 

$105

$120

$140

 

Food Plans(s)*

 

$105 (Includes Banquet)

Vegetarian* qty ___

 

Sat 6:30 Banquet Only

 

              $35

Vegetarian* qty ___

 

Souvenirs                          Qty                                                           Price

Puppet Family Album**

 

 

$25.00

 

T Shirt

 

Qty size L___

Qty size XL___

$16.00

 

                                                                Grand Total: (Due in US Funds):

 

 

*Please indicate other food allergies/concerns: _______________________________________________

** The Puppet Family Album includes pictures taken at this conference. Price includes shipping to

 a US address after the conference.  Please contact registrar for foreign shipping arrangements.

 

Payment Options: DO NOT SEND CASH! Only checks in US Funds payable to: Great Lakes Region P of A.

Check # _________ or Credit Card.                Credit Card Type: Visa □ Mastercard □

 

Name as it appears on card (Please print):_______________________________________

 

Card #________________________________Exp Date____________

 

Signature________________________________________________________________

 

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